Individual
MRS. LISA JANELLE GRANT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
55 FOGG RD, SOUTH SHORE HOSPITAL EMERGENCY DEPARTMENT, SOUTH WEYMOUTH, MA 02190-2432
(781) 340-3627
Mailing address
43 HERITAGE HL, DEDHAM, MA 02026-6206
(617) 999-7093
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
2234
MA
363AS0400X
Surgical Physician Assistant
2234
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1074133
PA-C LICENSE
MA
Enumeration date
10/20/2006
Last updated
06/01/2011
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